Medicare Boosting Coverage For Mental Health Issues

Medicare coverage for people with depression used to be, well, depressing. But that's starting to change.

In October, the Centers for Medicare and Medicaid Services began covering screening for depression without any cost-sharing when Medicare beneficiaries visit their primary care doctor.

That's a big deal, because although older people have lower rates of depression than the general population — 10.7 percent, compared with 16.9 percent overall — they often have other chronic conditions that may worsen if their depression isn't treated.

And depression often goes undiagnosed in the elderly, who may feel the stigma of mental illness more acutely than younger people and are often less likely to seek help. Paying doctors to screen for depression — Medicare's going rate is $17.36 per person — might well increase how often they do it, experts say.

"Doctors are trying to do the right thing, but how do you prioritize what to do in 21 minutes with a complex person?" asks Ken Duckworth, medical director for the National Alliance on Mental Illness. "If they get paid for it, they structure it into their practices."

The new preventive screening adds to coverage improvements in drug and mental health services in recent years.

For starters, Medicare Part D drug plans are required to cover essentially all antidepressant drugs. However, some plans may cover only the generic version of a particular drug.

In addition, Medicare used to lag private health plans in coverage of mental health services such as psychotherapy. That's improving, too.

Under the Mental Health Parity and Addiction Equity Act of 2008, private health plans have to cover both physical and mental health services equally. Medicare, which covered mental health services at 50 percent rather than the 80 percent rate for physical treatment, wasn't required to abide by the law.

The Medicare Improvements for Patients and Providers Act of 2008 changed that. Medicare is gradually increasing the percentage it covers for mental health services, until in 2014 it will reach 80 percent. (In 2012, the program covers 60 percent.)

Although coverage has improved, there's one area where Medicare still lags private plans, says Andrew Sperling, director of legislative advocacy at the National Alliance on Mental Illness.

"Coverage is still inequitable with respect to inpatient psychiatric care," he says. Medicare pays for up to 190 days of inpatient care during a beneficiary's lifetime, a limit that doesn't typically apply in private health plans.